Advances in the Etiology and Management of Hyperinsulinemic Hypoglycemia After Roux-en-Y Gastric Bypass

Y, Cui; Elahi, Dariush; Andersen, Dana K.

doi:10.1007/s11605-011-1585-8

Cited by 64 publications

(51 citation statements)

References 109 publications

(102 reference statements)

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“…This finding is supported by the data from a Swedish nationwide cohort study, where incidence of hospitalization for hypoglycemia after RyGB was found to be 0.2% as compared to only 0.04% in the reference population (31). Most cases of hypoglycemia after RyGB are successfully treated with low carbohydrate diet or with diazoxide, octreotide, acarbose or calcium-channel blockers (32). In severe cases, surgical intervention (reversal of RyGB, conversion of RyGB to SG, placement of adjustable gastric band over RyGB, or even subtotal/total pancreatectomy) has been proposed.…”

Section: Surgery Versus Conventional Treatmentsupporting

confidence: 52%

Surgery in the treatment of type 2 diabetes mellitus

et al. 2015

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Background and Aims: the prevalence of diabetes is increasing worldwide, and most of the cases are type 2 diabetes mellitus. the relationship between type 2 diabetes mellitus and obesity is well established, and surgical treatment is widely used for obese patients with type 2 diabetes mellitus. the aim was to present current knowledge about the possible mechanisms responsible for glucose control after surgical procedures and to review the surgical treatment results.Material and Methods: medical literature was searched for the articles presenting the impact of surgical treatment on glycemic control, long-term results, and possible mechanisms of action among obese individuals with type 2 diabetes mellitus.Results: remission of type 2 diabetes mellitus after bariatric surgery depends on the definition of the remission used. complete remission rate after surgery with the new criteria is lower than was considered before. randomized controlled studies demonstrate that surgery is superior to best medical treatment for the patients with type 2 diabetes mellitus. the recurrence of type 2 diabetes mellitus after bariatric surgery is observed in up to 40% of cases with ≥5 years of follow-up. despite the recurrence of type 2 diabetes mellitus in this group, better glycemic control and lower risk of macrovascular complications are present. incretin effects on glycemic control after bariatric surgery are well described, but the role of other possible mechanisms (bile acids, microbiota, intestinal gluconeogenesis) in humans is unclear.Conclusion: Surgery is an effective treatment of type 2 diabetes mellitus in obese patients. the most optimal surgical procedure for the treatment of obese patients with type 2 diabetes mellitus is still to be established. more research is needed to explore the mechanisms of glycemic control after bariatric surgery.

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Section: Surgery Versus Conventional Treatmentsupporting

confidence: 52%

Surgery in the treatment of type 2 diabetes mellitus

et al. 2015

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“…Criteria for assessment of effect of bariatric surgery on optimization of metabolic status and some other co-morbid conditions [58] : -HbA1c ≤ 6%, no hypoglycaemia, total cholesterol < 4 mmol/l, LDL-cholesterol < 2 mmol/l, triglycerides < 2.2 mmol/l, blood pressure < 135/85 mmHg, >15% weight loss, or lowering of HbA1c by >20%, LDL< 2.3 mmol/l, blood pressure < 135/85 mm Hg with reduced medication from pre-operative status. In cases of postprandial hypoglycaemic symptoms, evidence for lowered blood glucose concurrent with symptoms should be looked for; patients should first be advised on dietary changes (low carbohydrate diets, regular meal times); second-line drug treatment may be considered, such as acarbose, calcium-channel antagonists, diazoxide, octreotide (EL C [188][189][190][191][192] .) Special care must be taken for: -The possible nutritional deficiencies such as vitamin, protein and other micronutrients.…”

Section: Follow-upmentioning

confidence: 99%

Interdisciplinary European Guidelines on Metabolic and Bariatric Surgery

et al. 2013

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In 2012, an outstanding expert panel derived from IFSO-EC (International Federation for the Surgery of Obesity -European Chapter) and EASO (European Association for the Study of Obesity), composed by key representatives of both Societies including past and present presidents together with EASO's OMTF (Obesity Management Task Force) chair, agreed to devote the joint Medico-Surgical Workshop of both institutions to the topic of metabolic surgery as a pre-satellite of the 2013 European Congress on Obesity (ECO) to be held in Liverpool given the extraordinarily advancement made specifically in this field during the past years. It was further agreed to revise and update the 2008 Interdisciplinary European Guidelines on Surgery of Severe Obesity produced in cooperation of both Societies by focusing in particular on the evidence gathered in relation to the effects on diabetes during this lustrum and the subsequent changes that have taken place in patient eligibility criteria. The expert panel composition allowed the coverage of key disciplines in the comprehensive management of obesity and obesity-associated diseases, aimed specifically at updating the clinical guidelines to reflect current knowledge, expertise and evidence-based data on metabolic and bariatric surgery.

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“…This alteration in anatomy gives rise to side effects: early dumping symptoms and in some cases later discomfort due to postprandial hypoglycemia (PPHG) (2). The dumping syndrome is characterized as an attack within 10-30 min after eating with symptoms of dizziness, diaphoresis, flushing, nausea, bloating, and fatigue.…”

Section: Introductionmentioning

confidence: 99%

GLP1 analogs as treatment of postprandial hypoglycemia following gastric bypass surgery: a potential new indication?

Abrahamsson¹,

Engström

Sundbom

et al. 2013

European Journal of Endocrinology

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Objective: The number of morbidly obese subjects submitted to bariatric surgery is rising worldwide. In a fraction of patients undergoing gastric bypass (GBP), episodes with late postprandial hypoglycemia (PPHG) develop 1-3 years after surgery. The pathogenesis of this phenomenon is not fully understood; meal-induced rapid and exaggerated increases of circulating incretins and insulin appear to be at least partially responsible. Current treatments include low-carbohydrate diets, inhibition of glucose intestinal uptake, reduction of insulin secretion with calcium channel blockers, somatostatin analogs, or diazoxide, a K ATP channel opener. Even partial pancreatectomy has been advocated. In type 2 diabetes, GLP1 analogs have a well-documented effect of stabilizing glucose levels without causing hypoglycemia. Design: We explored GLP1 analogs as open treatment in five consecutive GBP cases seeking medical attention because of late postprandial hypoglycemic symptoms. Results: Glucose measured in connection with the episodes in four of the cases had been 2.7, 2.5, 1.8, and 1.6 mmol/l respectively. The patients consistently described that the analogs eliminated their symptoms, which relapsed in four of the five patients when treatment was reduced/discontinued. The drug effect was further documented in one case by repeated 24-h continuous glucose measurements.Conclusion: These open, uncontrolled observations suggest that GLP1 analogs might provide a new treatment option in patients with problems of late PPHG.

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Advances in the Etiology and Management of Hyperinsulinemic Hypoglycemia After Roux-en-Y Gastric Bypass

Cited by 64 publications

References 109 publications

Surgery in the treatment of type 2 diabetes mellitus

Surgery in the treatment of type 2 diabetes mellitus

Interdisciplinary European Guidelines on Metabolic and Bariatric Surgery

GLP1 analogs as treatment of postprandial hypoglycemia following gastric bypass surgery: a potential new indication?

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